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Pancreas Cancer News and Archives | |
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For educational purposes only; not to be relied upon. Please read Pancreatica Disclaimer | |
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Combination Chemotherapy and Surgery Improve Survival of Patients with Unresectable Pancreatic Cancer October 21, 2003 A four-drug chemotherapy regimen plus surgical resection markedly increased survival in a cancer patient group that typically has a dismal prognosis-those with pancreatic cancer that is so locally advanced it cannot be removed surgically. The regimen was tested in a small study conducted at a single cancer treatment center. The results were reported at the 2003 Clinical Congress of the American College of Surgeons. "Our findings need to be duplicated by other investigators in other centers before people really should get excited about them," cautioned Howard Reber, MD, FACS, professor of surgery and chief of gastrointestinal surgery at the University of California Los Angeles, where the study was done. Nevertheless, the treatment strategy produced impressive results for 12 patients with unresectable pancreatic cancer. "If you look at the population of patients with unresectable pancreatic cancer who are treated the traditional way, the median survival is usually 10 months; so these patients have a 50 percent statistical probability of dying in eight to 10 months. We took such patients, put them on this regimen, and tripled their survival rate," said William Isacoff, MD, assistant clinical professor in the department of hematology and oncology at the UCLA Jonsson Comprehensive Cancer Center. According to findings from the study, median survival from the time of diagnosis was 35 months in those patients who underwent surgical resection. All Resected patients lived for a year after treatment; 82 percent lived for two years; 41 percent lived for three years, and 27 percent lived for four years. Although seven of the 12 patients died of recurrent disease, five were still alive and disease free between 10 and 117 months after diagnosis. The treatment approach departs from standard therapy for pancreatic cancer, which focuses predominantly on the pancreas, Dr. Isacoff said. Most clinicians over the last 30 years have combined radiation therapy with 5-fluorouracil-based chemotherapy to treat patients with locally advanced disease, he explained. The chemotherapeutic agent 5-FU has been added as a sensitizer to enhance the efficacy of radiation therapy on pancreatic tumors. However, at the time of diagnosis, as many as 85 percent or 90 percent of patients with pancreatic cancer have microscopic metastases that are too small to detect by current scanning techniques. "For patients who present with unresectable pancreatic cancer, the role of therapy has focused on the pancreas. But three months after they finish radiation, many patients have liver metastases. Well, the liver metastases were already there, too small to see; so what the patients needed was effective systemic treatment," Dr. Isacoff said. Rather than providing chemotherapy in high doses for a fixed number of treatment cycles over two to four months, physicians in the study gave low-dose chemotherapy as continuous treatment as long as the patient continued to respond. "We decided to treat as long as there was benefit, meaning patients had no obvious progression of disease locally or systemically during treatment," Dr. Isacoff said. Patients in the study were thought to be candidates for surgery to remove their pancreatic tumors. However, during an exploratory procedure, surgeons discovered that the pancreatic tumors were so extensive, the growths could not be excised. Therefore, the patients were treated with chemotherapy in an attempt to shrink the tumors to a resectable size. Patients received a continuous infusion of 5-FU at a dose of 200 mg per meter squared per day; an intravenous bolus of calcium leucovorin every week at a dose of 30 mg per meter squared; an intravenous infusion of mitomycin-C at a dose of 10 mg per meter squared every six weeks; and oral dipyridamole at a dose of 75 mg every day. After chemotherapy, pancreatic tumors in all but one patient were small enough to remove surgically, Dr. Reber said. Administering chemotherapy to reduce the size of unresectable malignancies is known as "downstaging cancer." "The concept of downstaging is not unusual, but the experience of downstaging so many patients is. That method is not commonly seen in treating pancreatic cancer This is an unusually good result," said Dr. Reber. Hiroyuki Shinchi, MD; John Duffy, MD; and Oscar Hines, MD, FACS, ME; joined Drs. Isacoff and Reber in the study of patients with unresectable pancreatic cancer.
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